You should have a thorough history and examination before beginning HRT. This should include all of the following:
- a full check of your general health, including the occurrence of any symptoms that may be related to menopause (hot flushes, headaches, vaginal dryness, for example), and an assessment of any social and psychological factors that may be contributing to your situation
- an assessment of your present and past menstrual cycle, including any changes to the pattern of your periods, their frequency, and the amount of blood los
- a discussion of your lifestyle, including exercise and nutrition patterns and your use of medications, alcohol and cigarettes
- details of any previous medical, obstetrical, gynaecological or psychological symptoms, and any personal or family history of breast cancer or breast lumps, blood clot formation, heart attack or stroke, fractures or osteoporosis, uterine fibroids, endometriosis, problems experienced with the Pill, liver
- weight and blood pressure measurements, an examination of the breasts and vagina (to check the cervix, uterus and ovaries), and a Pap smear if you have not had one within the past two years
- a mammogram, especially if you have a family or personal history of breast problems
- an assessment of blood fat levels (cholesterol and triglycerides) if this has not been made during the previous twelve months
- a bone density scan if, at any time during the fertile years, menstruation stopped unexpectedly for longer than six months; and also if you have used, or still use, steroids (for example, in asthma or thyroid treatment), have had a recent fracture, have a family history of fractures or osteoporosis, or for any reason regard bone density information as an important part of your decision about HRT
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